title: Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence.
abstract: BACKGROUND
  The health and economic burden of physical inactivity is well documented. A wide range of primary care and community-based interventions are available to increase physical activity. It is important to identify which components of these interventions provide the best value for money.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of physical activity interventions in primary care and the community.
  
  
  METHODS
  Systematic review of cost-effectiveness studies based on randomised controlled trials of interventions to increase adult physical activity that were based in primary health care or the community, completed between 2002 and 2009.
  
  
  METHODS
  Electronic databases were searched to identify relevant literature. Results and study quality were assessed by two researchers, using Drummond's checklist for economic evaluations. Cost-effectiveness ratios for moving one person from inactive to active, and cost-utility ratios (cost per quality-adjusted life-year [QALY]) were compared between interventions.
  
  
  RESULTS
  Thirteen studies fulfilled the inclusion criteria. Eight studies were of good or excellent quality. Interventions, study populations, and study designs were heterogeneous, making comparisons difficult. The cost to move one person to the 'active' category at 12 months was estimated for four interventions ranging from €331 to €3673. The cost-utility was estimated in nine studies, and varied from €348 to €86,877 per QALY.
  
  
  CONCLUSIONS
  Most interventions to increase physical activity were cost-effective, especially where direct supervision or instruction was not required. Walking, exercise groups, or brief exercise advice on prescription delivered in person, or by phone or mail appeared to be more cost-effective than supervised gym-based exercise classes or instructor-led walking programmes. Many physical activity interventions had similar cost-utility estimates to funded pharmaceutical interventions and should be considered for funding at a similar level.
authors.affiliation: Women's Health Research Centre, University of Otago, Wellington, New Zealand. susan.garrett@otago.ac.nz
authors.forename: Sue
authors.initials: S
authors.lastname: Garrett
authors.forename: C Raina
authors.initials: CR
authors.lastname: Elley
authors.forename: Sally B
authors.initials: SB
authors.lastname: Rose
authors.forename: Des
authors.initials: D
authors.lastname: O'Dea
authors.forename: Beverley A
authors.initials: BA
authors.lastname: Lawton
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Dowell
mesh_terms: D003362:Cost-Benefit Analysis; D015444:Exercise; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D008019:Life Style; D009520:New Zealand; D010809:Physical Fitness; D011320:Primary Health Care / Q000191:economics*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic